Accredited Social Health Activists struggle for survival

Over nine lakh women from India's all-women workforce commonly referred to as ASHA workers (Accredited Social Health Activist) are angry and upset with their working conditions.

This pandemic in the past few months has made their jobs more challenging than ever. Since the COVID-19 breakout, ASHA workers are at the frontline conducting door to door surveys, tracing their communities for COVID-19 symptoms, and spreading awareness amongst people for precautions. They are doing this without proper training, PPE kits, and lack in supply of gloves, masks, and hand sanitisers.

With delayed salaries and lack of basic protection equipment,  they are spending from their own pockets to stay safe as they go door to door conducting surveys, tracking cases, and spreading awareness regarding COVID-19.

As the government pushed more than nine lakh ASHA workers as frontline COVID-19 warriors without ensuring proper equipment and safety measures, they are at risk and so are their families.

Since the lockdown began there have been numerous reports about ASHA workers and their family members contracting the virus and dying.

Reportedly, at least 100 Asha workers have lost their lives.

ASHA workers have alleged that they are not receiving their payments for COVID-19 work promised by the government on time due to which they end up spending from their own pockets. Following a protest at Jantar Mantar in Delhi, instead of reassurance from the government, they faced FIRs for demanding their due.

On August 7, around six lakh ASHA workers went on strike to demand a minimum wage of Rs. 21,000 per month, PPE kits, and medical insurance for their families.

On August 17, ASHA workers went on strike in Haryana as the government gave them 4G sim cards without giving them smartphones and disabled their previous sim cards. This move would automatically lead them to buy new 4G sim compatible phones with better technology out of their own pockets to carry out their government duties. Instances of such strikes have been reported widely from across the country over the past few months, yet the government continues to turn a blind eye to the woes of these workers.

Currently, an ASHA worker receives a monthly honorarium of Rs 2000-4000, depending on the state she works in along with meagre performance-based incentives that at best can go up to Rs.1000 a month. Despite the fact that there are more than nine lakh women working as ASHA workers, there is no uniformity across states and Union Territories when it comes to a fixed and timely honorarium for them.

Though they work at par with or even more than those in regular jobs, they still are not eligible for a minimum wage. Patients from their community can call them 24×7 for queries on symptoms and other public health services. It is not an easy job. Still, it is only recognised as a volunteer service and not a job.

These women are neither unskilled nor unorganised labour. They are recruited through a rigorous procedure by the government that looks at their eligibility. After being selected they are trained for administering basic health care and administration of drugs for common ailments. Yet. in public perception they are seen as mere volunteers.

In many ways, it is a reflection of how the government looks at these women who are today so crucial to the healthcare system in rural India.

ASHA workers have made waves in the past 15 years in making Public Health services accessible. ASHA workers are authorised by the government to act as health policy facilitators and link the marginalised communities in rural and urban areas with the government's health welfare programs.

They have been demanding the status of a government employee, and a minimum wage according to government rules for years. But their demands have fallen on deaf ears. The concept of ASHA was introduced in 2006 under the National Rural Health Mission (NRHM) to connect marginalised communities with the public health system.

ASHA workers, selected from the local community are the first port of call for any health-related demands and queries. They provide assistance to the marginalised communities who find it difficult to access health services.

It is ASHA workers who implement government schemes on the ground. Conducting door to door surveys, promoting family planning, facilitating services like Ante Natal Check-up, Post Natal Checkup, immunisation, sanitisation, overseeing construction of toilets, promoting hygiene, and so on.

Their contribution to reducing maternal mortality amongst the rural and urban poor, and immunisation especially for making India polio-free has only been acknowledged but never rewarded. It is important to note that these workers have to be women as the job requires skills that are historically associated with a woman's job.

Have you heard of a 9 lakh strong all-man workforce working for the government, providing essential services as "volunteer-activists"?

It is a common belief that patriarchy thrives on—that men and women are biologically different so there are some skills that are considered " naturally" gender-specific.

The skills that are considered "exclusive" to men, get them promotions and career advantages. But skills that have been historically seen to be better performed by women get them no such advantage. All they get is a label of "family duty" when delivered in a domestic setup and "social activism" when delivered to the nation at large.

One cannot ignore the inherent class bias when it comes to these women. Along with gender issues, there is also the struggle of underprivileged women to get recognition for their labour.

On one hand, India's social media is filled with the discourse on why women should be given leave by their organisations when they are on their periods, and on the other hand, lakhs of women who form a part of these health services are ignored.

Legal system failed them

The Minimum Wage Act that prescribes a minimum amount must be paid to an employee by the employer strangely does not apply to ASHA and Anganwadi workers. In absence of any defined nomenclature that makes them "worker" and not mere "volunteer" who is entitled to honorariums and not salaries the ASHA and Anganwadi workers fall under a "project" and not under any "industry" to get a fixed wage for their labour.

For instance, in a 2006 judgment, rejecting the claims of Anganwadi worker to a minimum wage, the Supreme Court upheld that the Act does not cover Anganwadi workers under the Integrated Child Development Scheme (ICDS) as the workers don't fall under the "industries" mentioned in the act. The court remarked that Anganwadi's were not "industrial workmen".

In 2016, in State of Punjab v.s Jagjit Singh the Supreme court observed that "temporary employees performing similar duties and functions, as discharged by permanent employees, are entitled to draw wages at par with permanent employees in the government sector." What makes this judgment a landmark case for ASHA and Anganwadi workers is that the court made it clear that a mere difference in nomenclature should not deprive an employee from being paid a similar wage that a permanent employee gets for the same amount of work. The court called it an act of "exploitative enslavement" to not pay someone an equal amount for equal work performed.

Four years have passed since the judgment.

ASHA workers continue to struggle to be recognised as workers so as to get a minimum respectable wage while they actively battle COVID-19 in various corners of India.

(Nupur Dogra is an independent journalist.)